Maurice A. Cerulli

Incremental yield of dysplasia detection in Barrett’s esophagus using volumetric laser endomicroscopy with and without laser marking compared with a standardized random biopsy protocol

BACKGROUND AND AIMSnVolumetric laser endomicroscopy (VLE) is a new wide-field advanced imaging technology for Barretts esophagus (BE). No data exist on incremental yield of dysplasia detection. Our aim is to report the incremental yield of dysplasia detection in BE using VLE.nnnMETHODSnThis is a retrospective study from a prospectively maintained database from 2011 to 2017 comparing the dysplasia yield of 4 different surveillance strategies in an academic BE tertiary care referral center. The groups were (1) random biopsies (RB), (2) Seattle protocol random biopsies (SP), (3) VLE without laser marking (VLE), and (4) VLE with laser marking (VLEL).nnnRESULTSnA total of 448 consecutive patients (79 RB, 95 SP, 168 VLE, and 106 VLEL) met the inclusion criteria. After adjusting for visible lesions, the total dysplasia yield was 5.7%, 19.6%, 24.8%, and 33.7%, respectively. When compared with just the SP group, the VLEL group had statistically higher rates of overall dysplasia yield (19.6% vs 33.7%, Pxa0= .03; odds ratio, 2.1, Pxa0= .03). Both the VLEL and VLE groups had statistically significant differences in neoplasia (high-grade dysplasia and intramucosal cancer) detection compared with the SP group (14% vs 1%, Pxa0= .001 and 11% vs 1%, Pxa0= .003).nnnCONCLUSIONnA surveillance strategy involving VLEL led to a statistically significant higher yield of dysplasia and neoplasia detection compared with a standard random biopsy protocol. These results support the use of VLEL for surveillance in BE in academic centers.

Downhill Esophageal Varices Associated With Central Venous Catheter-Related Thrombosis Managed With Endoscopic and Surgical Therapy

Downhill esophageal varices are a rare cause of upper gastrointestinal hemorrhage. We present a case of downhill variceal bleeding due to superior vena cava thrombosis resulting from a prior central venous catheter. The patient was managed with endoscopic band ligation and later with surgical axillary vein to right atrium bypass grafting. Successful long-term resolution of varices was achieved at 1 year of follow-up. This is the longest follow-up described for combined endoscopic and surgical management in the existing literature for catheter-associated downhill varices.

The importance of endoscopic retrograde cholangiopancreatography in a young female with acute recurrent pancreatitis.

Anomalies of the pancreaticobiliary junction were first described by Arnolds in 1906 [1]. The prevalence of these conditions varies widely across races and is about to 1 in 1,000 in Asians compared to 1 in 100,000 in the European population [2]. Nearly 50% of these cases are congenital and are seen in children (18 years of age or less). Congenital anomalies of the pancreaticobiliary junction are usually asymptomatic and may present with associated conditions, ranging from benign acute abdominal pain and biliary ductal cysts to carcinomas. APBJ can rarely be associated with other pancreatic ductal anomalies. This case emphasizes the role of endoscopic retrograde cholangiopancreatography (ERCP) in such cases. Case Description